TALK TO US, LISTEN TO US, WORK WITH US
Professor Norma Raynes
In 2005 professional discussions about older people still involve for the most part
• thinking about health and social care services
• talking about them as burdens
• seeing them as contributing to the pension’s crisis
• seeing them as different from other members of the society in which they live.
Strangely it does not seem to include talking to them, or listening to them, unless of course a statutory duty to do this is a requirement for the professionals who are responsible for delivering services. At the macro planning level the elderly support ratio symbolises an ever increasing imbalance with older people, growing in number (1) supported by a diminishing number of younger workers. Essentially it represents the drain on society of increasing numbers of older people with pathologies that require treatment or that cannot be treated and thus need some kind of palliative input. Enter social care agencies reducing isolation, providing aids and adaptations and necessary access to food services for people living in their own homes, separated from caring families as our society becomes increasingly mobile. Decreasing resources and growing numbers of needy old people have meant means testing and targeting of scarce resources. Thus more and more services go to fewer and fewer people (2).
Is this what older people are really like? Is this what older people want? Is this what we want to be the future landscape in which we will all be located as inevitably we move through the seven ages of man and woman? Will it look like this in 2030 or 2050? There is no doubt that it could look very similar unless a radical rethink of the role and nature of old people rather than a radical rethink of the services provided for them is the place we start from in our thinking about the future.
In other parts of Europe, Denmark for instance, there has been at national level an older people’s council. This has existed for several years now. In England we have reference groups associated with government departments. We have the Older People’s Advisory Group supported by Better Government for Older People. Since the 1990s we have seen a range of initiatives to bring older people into central roles in looking at what would enable them to remain independent and live in their own homes, as most want to do. Exploring what would assist their continued contribution, as members of their local communities and the wider society and just to live a life that can be enjoyed. Many examples of this involvement have occurred. Yet notwithstanding all of these the Joseph Rowntree Older Peoples steering group noted as recently as 2004 that it is, dispiriting that there are so few good examples of the meaningful involvement of older people either locally or nationally. They went on to say that, Unless programmes or strategies about older people have the fullest possible involvement of older people in their development, they are very unlikely to stand the test of time (3).
SOME CHANGES AND CHALLENGES
People in their fifties or early sixties, the baby boomers, are said to be different in their aspirations and expectations from those over 70 (4). They were of course the first beneficiaries of state education, improved post war nutrition and rising standards of living. Whatever their expectations, which seem to have been the focus of most research, we can assume that they will be healthier than their predecessors at a similar age. How this will impact on morbidity in the future remains to be seen, as is pointed out in the government’s strategy document Opportunity Age. . We will have to wait and see and monitor. As the strategy document says we will have to monitor trends carefully and address inequalities. It is noted in the same document however, that the broad picture is that the years after retirement are largely healthy and can be made even healthier through relatively simple preventive measures (para 1.29) (5).
We can make fewer and fewer assumptions about what older people set to become 60 , 70 and eighty over the next thirty years will be like. We already hear the phrases “but you don’t look your age” or”” you don’t look 60/70/80.” or “you look marvellous for your age” As our preconceptions of what it is we should expect to look like, once we are pensioners are being challenged on a daily basis by those who don’t use plastic surgery, so our assumptions about what it is we can expect in terms of health and wellbeing need to be and will be challenged. We will have to challenge in essence our understanding of the role and place of older people. Those people we have decided are old because they are of pensionable age and thus different from those who earn a weekly wage or monthly salary.
Challenges are already becoming visible. Many grandparents now provide an unpaid regular support service to enable their children to go out to work. They take and meet children coming from school and look after them in holiday periods. Actors, actresses, musicians continue to work into their eighties. Opportunity Age argues the case for enabling those who want to work to do so without losing pension rights. It argues the need for flexible working arrangements. This is not just to benefit older people who want to remain at work but of course the wider society that will benefit from their continued contribution to the GNP. Enabling this to happen across the board means that employers will need to rethink the nature of the workplace. In Finland an occupational health approach to older workers has been in place for many years. It places responsibility equally on the employer and employee to ensure that productivity remains high for both parties.
Not only our work environments need to be scrutinised to ensure that they support continued productivity but our living and leisure environments need similar scrutiny. In Ageing Foresight (6) the point was made that if you design for older people you design for everyone. The concept of Inclusive Design is the design articulation of this idea (7). Such an approach to design is rather like old people, it is in no way main stream in the thinking of designers and manufacturers or city planners in England. With a steer from the government and evidence of the business benefits and profits for such developments our environments could be improved for all ages.
A PLACE WORTH GETTING TO
Such an environment for all ages is one in which a society for all ages could more comfortably exist. It would be one in which older people were routinely involved in discussions at local and national level about strategic plans, their implementation and their monitoring. This way we could achieve a landscape whose characteristics would be such that we could:
• Be healthy
• Stay safe
• Enjoy and achieve
• Make a positive contribution
• Achieve economic well-being (8)
This I’d suggest is one we would all rather be moving to than a service dominated world that is unlikely to provide the kind of help we might need when we want it.
1 Office for National Statistics (2004a) Population Trends 118 – Interim 2003-based national population projections for the United Kingdom and constituent countries, Winter, 2004.
2 Association of Directors of Social Services and Local Government Association (2003) All Our Tomorrows, London, ADSS/LGA
3 Older People’s Steering Group (2004) Older People Shaping Policy and Practice, Joseph Rowntree Foundation, York.
4 Evandrou, M (1997) ed Baby Boomers: Ageing in the 21st Century Age Concern London
5 HM Government (2005) Opportunity Age. Meeting the challenges of ageing in the 21st century HMSO, London.
6 DTI (2000) Foresight Panel on Ageing DTI, London
7 Coleman, R (2001) Living Longer, Design Council, London.
8 Dfes (2003) Every Child Matters Dfes London